Meter Swap �
` Request Number: 16115
Public Works Division
Service Request
Problem Address: 254 Rice Creek Bl�d Requested By: Newah
Department: WATER Address: No a�ress p�ovided
Problem/Issue: INSTAL,L AMR ME'IER Phone Numberc 612-599-6716
Scheduled Date: 2017-06-26 5chednled 1lme: 01:30:00
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I
ACTION NEEDED:
Created by: Beth I�ondrick Date Cres�ted: 2017-06-23
ACTION TAI�N:
.....__ _.._..._..__.........................._._.__._.__...._._���`�- _�1�'� _._._ __._________..__
5tatvs: In Progress Sabmitter Has Been �
Contacted
Date Completed: Comple d
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. City of Fridley
Water Department ��� (���
6431 University Avenue NE
Fridley,MN 55432
763-572-3566
�1`"�e hereby authorize the City of Fridley and/or fts empioyees to do what is necessary to
replace the water meter. 1 understand that the property awner is liabte for the water line from the main to the premise and all irrterior
plumbing. (Per Gty code 402.06) I also hold the Ctty of Fridley a�d/its employees hasmless for any damages tfiat may occur whiie doing this
operation. This to include,but oot limited to valves,piping,wails,floors or the curb stop box and senrice line. In understand 1 am also e�equired
to obtain a permit prior to any work,if necessary;
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FINAL METER READING(old meter) C� �v
Name: Address �t��,�I I J1.��
Phone Number Date "'�'� �
�/ .
Signature Y Witness Signature -
OLD METER#_ �� �t`,' �� L�3 l,�} �-�1`�' �� � I t7�
OLD READING _ ��� p -�V
NEW METER# _ � (� � �b I �j
NEW READING �
ERT#_ �.S�_�p�, J ��
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FRIDLEY CITY CODE
CHAPTER 402.WATER,STORM WATER AND SANITARY SEWER
�1DMINISTRATION
(Ref Ord No 113,464,565,566,629,638,662,922,988,1144,1156,1191j
402.5 PERMIT FEE
Prior to constructing or repair of any water of sewer line connecting the existing municipal system and any house or buiiding for which the
application is made,the owner or contractor shall be required to obtain a permit tor such connection,and shall pay a permit fee as provided in
Chapter il of this Code. After such connection has been made,the Water and Sewer Departmerst sha{I be natPfied. It shaN be uniawful io cover
any connecting line until an inspection has been made and such connection and the work incident thereto has been approved try the City as a
proper and suitable connection.
$02.06 REPAIRS AND MAlNTEMANCE TO COPINECT{ON
After the initia(connection has been made to the wate�senrice curb stop bax or the sewer lead at tfie property line or a water service lead has
been extended to the property line for connection,the applicant,owner,or occupant or user of such premisQs shall be liabte for a0 repain
required to any water line and sewer lines necessary for connection af the premises from the main to the premises. If the property owner
requests mairrtenance service or repairs be performed by the City,the property owner shall be charged for the costs of the mai�tenance and/or
repairs,inciuding necessary street repairs at a rate set annuaffy by an administrative poliry. It shall be the responsibility of the aqplicarit,
owner,occupant or user to perform standard mair�tenance of the sewer service{ine from the premises to the main inciuding debris dearing or
root cutting and to mairrtain the water service curb stop boz for operability and at such height as wili ensure that it remains above the finisfied
grade of the land or property. (Ref 638,1156,1191) .
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���-7�� City of Fridley
Water Department
Address_,�.J � � �.,t � � �J11�
Name..��1 yL��, /fY�i�.;a l�h
I�`�'� 5---�' c��
y Date
�..�' Old Meter Number �9 3 (a��T l
/
Old Meter Reading � �b
Replacement No. �Q � v
v
Replacement Reading d
Replacement Make ,���--.�.�
ERT#_ �-� � / � / S'�/
Replacement ERT#
Remarks: � /� �,
Signed ^:,_�_
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